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Fellowship Director: Maleewan Kitcharoensakkul, MD

The Division of Pediatric Rheumatology and Immunology provides a nationally recognized, ACGME accredited fellowship program in pediatric rheumatology. The program can accommodate one to two fellows each year and is tailored to the individual fellow’s interest and previous experience. The objective of the program is to prepare fellows for careers as academic pediatric rheumatologists by providing rigorous clinical training as well as a firm foundation in basic or clinical research.

The first year of the fellowship provides a focused, intensive exposure to clinical rheumatology. Depending on their long-term objectives, the fellows spend between six and nine months during the first year on the inpatient consult service where they gradually take on more responsibility for the care of hospitalized patients with rheumatologic diseases and immunodeficiencies. During these months, they will also have the opportunity to see approximately five to ten patients per week in the infusion center, as well as perform 25-35 intraarticular joint injections each year in the outpatient procedure center. They will also participate in two half-day outpatient clinics per week where under the supervision of an attending physician, they will each see approximately ten outpatients with a wide variety of rheumatologic disorders (including juvenile rheumatoid arthritis [JRA], spondylarthropathies, systemic lupus erythematosus [SLE], mixed connective tissue disease, Sjogren’s syndrome, juvenile dermatomyositis [JDMS], vasculitis, chronic pain syndromes, sarcoidosis, morphea, systemic sclerosis, Bechet’s, CRMO, periodic fever syndromes). They also have the option of participating in a weekly immunodeficiency clinic. They will also see JIA patients in a specialized half-day clinic at Shriner’s hospital twice a month. The fellows have the opportunity to participate in elective rotations tailored to fit their interests and long-term goals (e.g., musculoskeletal radiology, pediatric orthopedics or adult rheumatology). During the first year, each fellow is also provided time to investigate research opportunities within the Washington University Medical Center and guidance in identifying a research mentor. The fellows are allowed great latitude in selecting a research mentor from throughout the Washington University faculty.

During the second and third year, the fellows are provided the opportunity to primarily focus on research. This time allows the fellows to become firmly grounded in the skills necessary to complete a basic or clinical research project. They work closely with their identified mentors to develop an independent research project, design a plan to complete the project, troubleshoot problems as they occur, analyze their data and write up their results for publication. The goal is for the trainees to have their results published in a peer-reviewed journal and ultimately to be equipped to compete for extramural funding as independent investigators. In addition during the second and third years, the fellows continue to hone their clinical skills by participating in a weekly one half-day rheumatology clinic where they gradually take on more and more independence under the supervision of an attending physician. Depending on the fellow’s long-term objectives, they may also spend several additional months on the inpatient consult service and may pick up an additional outpatient clinic per week.

The Division of Pediatric Rheumatology and Immunology provides ample didactic lectures, seminars and conferences to ensure that the fellows will acquire the necessary understanding of the pathophysiology, clinical features, diagnosis and management of the core diseases in the field of pediatric rheumatology. Fellows participate in the Department of Pediatrics Fellowship Core Curriculum which includes workshops and training on topics including grant writing, teaching, how to approach a job search and others. Furthermore, emphasis is placed on not only understanding the diseases and potential therapeutic options but also on elucidating the etiology and aberrant immunological mechanisms involved in the specific autoimmune and autoinflammatory disorders. Throughout the academic year, the fellows participate in a series of didactic lectures that systematically review the core disorders in pediatric rheumatology. In addition, the fellows participate in a weekly Division of Pediatric Rheumatology case conference as well as a weekly Translational Research conference and Rheumatology Grand Rounds held in conjunction with the adult Rheumatology Division at Washington University. The fellows periodically present at these conferences to develop effective communication skills. Depending on the fellows’ long-term interests, they are also encouraged to participate in other conferences and journal clubs on the medical campus (e.g., the Immunology Department’s weekly seminar series and work-in-progress seminars or the Department of Molecular Microbiology’s seminar series). Opportunities are also available for Fellows to enroll in graduate level courses in immunology, epidemiology, biostatistics, microbiology, genetics and study design.